“An area of increased popularity in dentistry is how we as dental professionals can help people with the myriad of symptoms caused by differing types of sleep related breathing disturbances. Some people just snore. Other people actually slow or stop breathing multiple times per night. The fallout of these illnesses result in people that walk around their daily lives tired. Snoring and sleep apnea can lead to people with day time irritability and needing naps to gain lost sleep for night time wakefulness. These disease cause a lack of oxygen to reach the brain. This can cause rebounding physiologic changes that effect other organ systems, such as the heart. It has been shown that there is a link between snoring and sleep apnea to TMD (temporomandibular disorder), GERD (gastro-esophogeal reflux disease), and bruxism (nightime grinding). All of these syndromal disease show outward signs on the teeth of effected individuals.
In my 1 year advanced education in general dentistry program at Fort Benning, Georgia, I had the opportunity to take on and treat soldiers dealing with the problems mentioned above. There are a lot of products on the market currently that we treat individuals with based upon their needs. The first step is for me to get a medical consult with a physician that has or will conduct a sleep study for the individual. A diagnosis and results of the sleep study must be obtained in writing to determine the nature and extent of the disease, so we may then proceed to treatment. Many individuals we see are currently undergoing medical intervention with breathing machines or have had surgery to correct anatomic reasons these disease occur. Some people ask for an oral appliance so they can use it on trips instead of taking their breathing machines with them. Others do not like their breathing machines or have opted out of surgery. When someone is ready to try a new approach, that is where I come in.
I am currently offering therapy with 2 appliances. Both are mouthpieces that fit over the upper and lower jaws and are connect to each other in a way to pull the lower jaw forward, thus providing more air to pass into the body. By pulling the lower jaw forward it postures the tongue forward, preventing collapse of the tissues into the airway. More air and less tissue impingement will decrease snoring and lead to increased oxygen availability for the body to use. I have grown very fond of the Thornton Adjustable Positioners (or TAP appliances). They have had numerous models made since their inception, all about the same with minor tweaks to make them better over the years. The current model is called the TAP-3 Elite. For less severe cases where sleep apnea is not the diagnosis and someone may just snore, I recommend an EMA appliance, which works in the same fashion as the TAP appliance, but is less modifiable.
With an initial consult and exam, we can make sure the paperwork and medical history is all in place and that the patient needs treatment. Some of the complex tooth issues that may lead to sleep apnea may need to be looked at and addressed, as they may be the cause and no appliance may be necessary. Either traditional dental treatments, or an appliance may be recommended. Once an appliance is decided upon, a few simple “pudding” impressions of the teeth and a bite record will be made. Our dental laboratory can then construct the appliance. At the insert appointment, instructions will be given and follow-up made to determine how far to pull the lower jaw forward. Once we locate that perfect end-point for therapy and the patient is getting results, a follow-up sleep study is done to evaluate the difference between the baseline sleep study and the therapeutic sleep study
The major point of concern is that patients are benefitting from the therapy and that no harm to the teeth is made. Some of the online sleep apnea and snoring appliances that are sold can cause bite changes that are detrimental to oral health. Please call me to engage into a discussion about your history and whether one of our snoring or sleep apnea appliances can help you. I always love treating patient’s in the most comprehensive manner. I feel extremely comfortable in helping guide anyone suffering from these diseases to a better lifestyle. Take care.”
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